Outcome of adrenalectomy for unilateral primary aldosteronism: International consensus and remission rates
Abstract
Background Although unilateral primary aldosteronism is the most common surgically correctable cause of hypertension there are no standard criteria to classify surgical outcomes. Methods The Primary Aldosteronism Surgical Outcome study reached consensus by an international panel of 31 experts, including 6 endocrine surgeons, using the Delphi method. On the basis of standardised criteria, remission (complete, partial, absent) rates for clinical and biochemical outcomes were determined in retrospective cohorts (n=30-99) of consecutive patients unilaterally adrenalectomized based on adrenal venous sampling from 12 tertiary centres in 9 countries over 4 continents. Findings Consensus was reached for 6 criteria of clinical and biochemical outcome and 2 recommendations for follow-up. Complete clinical success was achieved in 37% of patients, with a wide variance (17-62%), and partial clinical success in an additional 47% (35-66%); complete biochemical success was seen in 94% (83-100%). Female patients had a higher likelihood of complete clinical success (OR=2.25; 95% CI, 1.40-3.62) and clinical benefit (complete + partial clinical success) (OR=2.89; 95% CI, 1.49-5.59). Younger patients had a higher likelihood of complete clinical success (OR=0.95 per extra year; 95% CI, 0.93-0.98) and clinical benefit (OR=0.95 per extra year; 95% CI, 0.92-0.98). Higher levels of pre-operative medication were associated with lower levels of complete clinical success. Interpretation Standardised…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 30 participants or records.
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